Significance of a Glenoid Fossa Approach for Management of Extensive Lesions in the Lateral Skull Base

Abstract

This article is designed to relate our experiences with a glenoid fossa approach for exposing the outer border of extensive lesions in the lateral skull base. In this series, there were five large paragangliomas with the longest diameter of 6.5 cm in length, one large jugular schwannoma with extratemporal components, and one severe case of petromastoiditis with otogenic pachymeningitis, edema of the temporal lobe, and mental disorder. All lesions of these cases were treated via a glenoid fossa approach combined with other reasonable approaches. The glenoid fossa approach resulted in crucial advantages: 1) it effectively exposes the outer border of extensive lesions in the lateral skull base; 2) it provides safe distal control of the facial nerve and internal carotid artery in the skull base; 3) it obviates the need for anterior transposition or rerouting of the facial nerve; and 4) it obviates sacrifice of the intact middle ear or section the mandibular condyle. There is no postoperative mandibular dysfunction because the mandibular articular capsule and articular tubercle are kept intact. On the basis of our experiences, the glenoid fossa approach is a safe, quick, and useful design for adequate exposure of the outer border of extensive lesions in lateral skull base surgery.